Colorectal cancer-screening tests and associated health behaviors

  • Jean A Shapiro
    Address correspondence and reprint requests to: Jean A. Shapiro, PhD, Centers for Disease Control and Prevention, NCCDPHP, DCPC, Mailstop K-55, 4770 Buford Hwy NE, Atlanta, GA 30341-3717
    Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Laura.C Seeff
    Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Marion.R Nadel
    Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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      Background: Studies have shown that screening reduces colorectal cancer mortality. We analyzed national survey data to determine rates of use of fecal occult blood testing (FOBT) and sigmoidoscopy, and to determine if these rates differ by demographic factors and other health behaviors.
      Methods: A total of 52,754 respondents aged ≥50 years were questioned in the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey (a random-digit-dialing telephone survey of the non-institutionalized U.S. population) about their use of FOBT and sigmoidoscopy.
      Results: The age-adjusted proportion of respondents who reported having had a colorectal cancer screening test during the recommended time interval (past year for FOBT and past 5 years for sigmoidoscopy) was 19.8% for FOBT, 30.5% for sigmoidoscopy, and 41.1% for either FOBT or sigmoidoscopy. Rates of use of colorectal cancer screening tests were higher for those who had other screening tests (mammography, Papanicolaou smear, and cholesterol check). There were also differences in rates of use of colorectal cancer screening tests according to other health behaviors (smoking, seat belt use, fruit and vegetable intake, and physical activity) and several demographic factors. However, none of the subgroups that we examined reported a rate of FOBT use above 29% within the past year or a rate of sigmoidoscopy use above 41% within the past 5 years.
      Conclusions: While rates of use of FOBT and sigmoidoscopy were higher among people who practiced other healthy behaviors, rates of use were still quite low in all subgroups. There is a need for increased awareness of the importance of colorectal cancer screening.


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        • Greenlee R.T
        • Hill-Harmon M.B
        • Murray T
        • Thun M
        Cancer statistics, 2001.
        CA Cancer J Clin. 2001; 51: 15-36
        • Mandel J.S
        • Bond J.H
        • Church T.R
        • et al.
        Reducing mortality from colorectal cancer by screening for fecal occult blood.
        N Engl J Med. 1993; 328: 1365-1371
        • Kronborg O
        • Fenger C
        • Olsen J
        • Jorgensen O.D
        • Sondergaard O
        Randomised study of screening for colorectal cancer with faecal-occult-blood test.
        Lancet. 1996; 348: 1467-1471
        • Hardcastle J.D
        • Chamberlain J.O
        • Robinson M.H.E
        • et al.
        Randomised controlled trial of faecal-occult-blood screening for colorectal cancer.
        Lancet. 1996; 348: 1472-1477
        • Selby J.V
        • Friedman G.D
        • Quesenberry C.P
        • Weiss N.S
        A case-control study of screening sigmoidoscopy and mortality from colorectal cancer.
        N Engl J Med. 1992; 326: 653-657
        • Newcomb P.A
        • Norfleet R.G
        • Storer B.E
        • Surawicz T.S
        • Marcus P.M
        Screening sigmoidoscopy and colorectal cancer mortality.
        J Natl Cancer Inst. 1992; 84: 1572-1575
        • Muller A.D
        • Sonnenberg A
        Protection by endoscopy against death from colorectal cancer.
        Arch Intern Med. 1995; 155: 1741-1748
        • Smith R.A
        • von Eschenbach A.C
        • Wender R
        • et al.
        American Cancer Society (ACS) guidelines for the early detection of cancer.
        CA Cancer J Clin. 2001; 51: 38-75
        • U.S. Preventive Services Task Force
        Guide to clinical preventive services. 2nd ed. International Medical Publishing, Alexandria, VA1996
        • Frankel L.R
        The report of the CASRO Task Force on response rates.
        in: Wiseman F Improving data quality in a sample survey. Marketing Science Institute, Cambridge, MA1983: 1-11
        • Winawer S.J
        • Fletcher R.H
        • Miller L
        • et al.
        Colorectal cancer screening.
        Gastroenterology. 1997; 112: 594-642
        • Ransohoff D.F
        • Lang C.A
        Screening for colorectal cancer with the fecal occult blood test.
        Ann Intern Med. 1997; 126: 811-822
      1. SAS statistical analysis software. Cary, NC: SAS Institute, 1996.

      2. SUDAAN Software for the Statistical Analysis of Correlated Data. Research Triangle Park, NC: Research Triangle Institute, 1997.

        • Centers for Disease Control and Prevention
        Screening for colorectal cancer United States, 1997.
        MMWR Morb Mort Wkly Rep. 1999; 48: 116-121
        • Eddy D
        ACS report on the cancer-related health checkup.
        CA Cancer J Clin. 1980; 30: 193-240
        • Brown M.L
        • Potosky A.L
        • Thompson G.B
        • Kessler L.G
        The knowledge and use of screening tests for colorectal and prostate cancer.
        Prev Med. 1990; 19: 562-574
        • Centers for Disease Control and Prevention
        Trends in cancer screening United States, 1987 and 1992.
        MMWR Morb Mort Wkly Rep. 1995; 45: 57-61
        • Hoffman-Goetz L
        • Breen N.L
        • Meissner H
        The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States.
        Ethn Dis. 1998; 8: 43-51
        • Mandelson M.T
        • LaCroix A.Z
        • Anderson L.A
        • Nadel M.R
        • Lee N.C
        Comparison of self-reported fecal occult blood testing with automated laboratory records among older women in a health maintenance organization.
        Am J Epidemiol. 1999; 150: 617-621
        • Mayer-Oakes S.A
        • Atchison K.A
        • Matthias R.E
        • DeJong F.J
        • Lubben J
        • Schweitzer S.O
        Mammography use in older women with regular physicians.
        Am J Prev Med. 1996; 12: 44-50
        • Rakowski W
        • Rimer B.K
        • Bryant S.A
        Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.
        Public Health Rep. 1993; 108: 605-624
        • Sutton S
        • Bickler G
        • Sancho-Aldridge J
        • Saidi G
        Prospective study of predictors of attendance for breast screening in inner London.
        J Epidemiol Community Health. 1994; 48: 65-73
      3. U.S. Bureau of the Census. Phoneless in America. Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 1994 (Statistical brief 94-16).

        • Gordon N.P
        • Hiatt R.A
        • Lampert D.I
        Concordance of self-reported data and medical record audit for six cancer screening procedures.
        J Natl Cancer Inst. 1993; 85: 566-570
        • Brown J.B
        • Adams M.E
        Patients as reliable reporters of medical care process.
        Med Care. 1992; 30: 400-411
        • Montano D.E
        • Phillips W.R
        Cancer screening by primary care physicians.
        Am J Public Health. 1995; 85: 795-800
        • Baier M
        • Calonge N
        • Cutter G
        • et al.
        Validity of self-reported colorectal cancer screening behavior.
        Cancer Epi Bio Prev. 2000; 9: 229-232